Radiation Exposure Among Orthopaedic Trauma Surgeons: Deconstructing Commonly Held Myths and Misperceptions.

OBJECTIVES: To review and evaluate the validity of common perceptions and practices regarding radiation safety in orthopaedic trauma. DESIGN: Retrospective study. SETTING: Level 1 trauma center. SUBJECTS: N/A. INTERVENTION: The intervention involved personal protective equipment. MAIN OUTCOME MEASUREMENTS: The main outcome measurements included radiation dose estimates. RESULTS: Surgeon radiation exposure estimates performed at the level of the thyroid, chest, and pelvis demonstrate an estimated total annual exposure of 1521 mR, 2452 mR, and 1129 mR, respectively. In all cases, wearing lead provides a significant reduction (90% or better) in the amount of radiation exposure (in both radiation risk and levels of radiation reaching the body) received by the surgeon. Surgeons are inadequately protected from radiation exposure with noncircumferential lead. The commonly accepted notion that there is negligible exposure when standing greater than 6 feet from the radiation source is misleading, particularly when cumulative exposure is considered. Finally, we demonstrated that trauma surgeons specializing in pelvis and acetabular fracture care are at an increased risk of exposure to potentially dangerous levels of radiation, given the amount of radiation required for their caseload. CONCLUSION: Common myths and misperceptions regarding radiation in orthopaedic trauma are unfounded. Proper use of circumferential personal protective equipment is critical in preventing excess radiation exposure.

Comparison of reamed long and short intramedullary nail constructs in unstable intertrochanteric femur fractures: A biomechanical study.

OBJECTIVES: There is no definitive evidence to guide clinicians in their decision-making for implant choice regarding long or short intramedullary nails for unstable fracture patterns. Historically short nails were associated with higher rates of perisprothetic fractures which seem to have improved with newer designs. Long intramedullary nails have higher blood loss and time under anesthesia. The purpose of this study was to assess stability of long and short intramedullary nail constructs in unstable intertrochanteric fracture patterns to better elucidate if unstable intertrochanteric fractures are amenable to treatment with short intramedullary nails. METHODS: This study utilized composite model femurs which were assigned to either a comminuted or reverse obliquity fracture pattern, then subsequently assigned to implantation with either a long or short intramedullary nail. All the samples were reamed to the level of the distal femur and instrumented with the appropriate nail. Axial and torsional stiffness as well as axial load to failure values were determined using a servohydraulic loading system. RESULTS: Short nail constructs exhibited significantly greater axial stiffness in A1 fractures and torsional stiffness in A3 fractures when compared with long nails. There was no significant difference between axial load to failure between long nails and short nails. DISCUSSION: We found no significant difference in axial load to failure values between long and short intramedullary nail fixation in 2 unstable intertrochanteric fracture patterns in a composite femur model. Short nails exhibited greater stiffness in axial loads in the A1 pattern and torsional stiffness in the A3 pattern. This suggests short or long intramedullary nails could be appropriately employed for fixation of unstable intertrochanteric hip fracture patterns.

Percutaneous Fixation of Calcaneal Tuberosity Avulsion Fracture.

There are little data published regarding percutaneous fixation of calcaneal tuberosity avulsion fractures, but tongue-type calcaneal fracture literature can be extrapolated to these injuries because they can be considered the extra-articular form of a tongue-type calcaneus fracture. Both injuries involve similar considerations regarding skin compromise and need for urgent management with similar percutaneous techniques to minimize further soft-tissue injury. Percutaneous fixation of tongue-type calcaneus fractures was first reported by Weshues and Gissane in their description of the Essex Lopresti maneuver as an alternative to open approaches to minimize the risk of soft-tissue complications and flap necrosis and provide a means of improving reductions in smokers and diabetics who may not otherwise be good operative candidates.

Preoperative Planning for Percutaneous Transsacral, Transiliac Screws.

Percutaneous transsacral, transiliac screw placement is a well-described, well-established management option for unstable posterior pelvic ring injuries. Safe and effective placement of these screws relies on extensive preoperative planning and scrutiny of the preoperative images. Malpositioning of the implants risks injury to the surrounding neurovascular structures. We present our methods for preoperative templating for safe placement of transsacral, transiliac screws.